Definition

What are esophageal varices?

Esophageal varices are abnormal condition when your veins swell in esophagus – the tube connects the throat and stomach. This condition usually occurs in people with serious liver diseases.

Esophageal varices develop when normal blood flow to the liver is blocked by a clot or scar tissue in the liver. To go around the blockages, blood flows into smaller blood vessels that aren’t designed to carry large volumes of blood. The vessels can leak blood or even rupture, causing life-threatening bleeding.

Once you have had a bleeding episode, your risk of another bleeding episode greatly increases. If you lose too much blood, you can go into shock, which can lead to death.

How common are esophageal varices?

This health condition is extremely common. It can affect patients at any age. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.

Symptoms

What are the symptoms of esophageal varices?

Esophageal varices do not usually cause signs and symptoms unless they bleed. Symptoms of bleeding esophageal varices include:

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes esophageal varices?

The most common cause of esophageal varices is scarring of the liver, which is called cirrhosis. Scarring causes blood to back up in the portal vein, the main vein that delivers blood from the stomach and intestines to the liver. This back up causes high blood pressure in the portal vein and other nearby veins, called portal hypertension. As a result, the blood needs to seek other pathways through smaller veins, such as those in the lowest part of the esophagus. These thin-walled veins balloon with the added blood. Sometimes the veins can rupture and bleed.

Blood clot (thrombosis). A blood clot in the portal vein or in a vein that feeds into the portal vein (splenic vein) can cause esophageal varices.

A parasitic infection. Schistosomiasis is a parasitic infection found in parts of Africa, South America, the Caribbean, the Middle East, and Southeast Asia. The parasite can damage the liver, as well as the lungs, intestine and bladder.

Risk factors

What increases my risk for esophageal varices?

There are many risk factors for esophageal varices, such as:

High portal vein pressure;

Large varices;

Red marks on the varices;

Severe cirrhosis or liver failure;

Continued alcohol use.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How are esophageal varices diagnosed?

If you have cirrhosis, your doctor should screen you for esophageal varices when you’re diagnosed. Some tests used to diagnose esophageal varices are:

Endoscope exam.

Imaging tests.

Capsule endoscopy.

How are esophageal varices treated?

Treatments to lower blood pressure in the portal vein may reduce the risk of bleeding esophageal varices. Treatments may include:

Medications to reduce pressure in the portal vein.A type of blood pressure drug called a beta blocker may be used in this case. These medications include propranolol (Inderal, Innopran) and nadolol (Corgard).

Using elastic bands to tie off bleeding veins.If your esophageal varices appear to have a high risk of bleeding, your doctor might recommend a procedure called band ligation.

Using an endoscope, the doctor snares the varices and wraps them with an elastic band, which essentially “strangles” the veins so they can’t bleed. Esophageal band ligation carries a small risk of complications, such as scarring of the esophagus.

If you are bleeding, the goal of treatment is to stop acute bleeding as soon as possible. Bleeding must be controlled quickly to prevent shock and death.

Using elastic bands to tie off bleeding veins.

Medications to slow blood flow into the portal vein.A drug called octreotide (Sandostatin) is often used with endoscopic therapy to slow the flow of blood from internal organs to the portal vein. The drug is usually continued for five days after a bleeding episode.

Diverting blood flows away from the portal vein.Your doctor might recommend a procedure called transjugular intrahepatic portosystemic shunt (TIPS) to place a shunt.

TIPS is mainly used when all other treatments have failed or as a temporary measure in people awaiting a liver transplant.

Restoring blood volume.You might be given a transfusion to replace lost blood and clotting factor to stop bleeding.

Preventing infection.There is an increased risk of infection with bleeding, so you’ll likely be given an antibiotic to prevent infection.

Replacing the diseased liver with a healthy one.Liver transplant is an option for people with severe liver disease or those who experience recurrent bleeding of esophageal varices. Although liver transplantation is often successful, the number of people awaiting transplants far outnumbers the available organs.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage esophageal varices?

The following lifestyles and home remedies might help you cope with esophageal varices:

Don’t drink alcohol.

Eat a healthy diet that’s full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat.

Maintain a healthy weight because obesity is associated with a greater risk of complications of cirrhosis. Lose weight if you are obese or overweight.

Use chemicals sparingly and carefully.Follow the directions on household chemicals, such as cleaning supplies and insect sprays. If you work around chemicals, follow all safety precautions. Your liver removes toxins from your body, so give it a break by limiting the amount of toxins it must process.

Reduce your risk of hepatitis. Protect yourself by abstaining from sex or using a condom if you choose to have sex. Ask your doctor whether you should be vaccinated for hepatitis B and hepatitis A.

If you have any questions, please consult with your doctor to better understand the best solution for you.